Economic burden of medication-overuse headache in Iran: direct and indirect costs.

BACKGROUND AND OBJECTIVE: Medication-overuse headache (MOH) as a secondary chronic headache imposes a considerable burden on both individuals and societies. Nevertheless, little is known about the burden of MOH in Iran. Therefore, in the current study, we aimed to quantify the annual cost of MOH among Iranian patients. METHODS: In this cross-sectional study, 84 patients were recruited. Demographic data, headache attack characteristics, related disability, and information about the economic burden of MOH were collected through face-to-face interview. Direct medical and nonmedical costs as well as indirect costs were included in our cost analysis. The prevalence-based approach was applied to estimate the economic burden of MOH. RESULTS: We found that MOH patients in Iran spend averagely $1046 for medical services, $132 for nonmedical services, and $1432 due to lost productivity per year. The per-person annual cost of MOH was US$2610, and the total annual cost for Iran was $10,179,000,000, with direct and indirect cost accounting for 45% and 55%, respectively. CONCLUSION: MOH leads to substantial healthcare costs and significant loss of productivity in Iran. Therefore, raising awareness in this area especially for policymakers can use in future health planning and lead to resource allocation in the field of disabling type of headache disorders such as MOH. Our findings also provide a different insight into the burden of MOH, which are likely closer to the actual costs in middle- and low-income countries, and also it could be a sample of such a study in western Asia.

Endoscopic-Assisted Lateral Orbitotomy for Large Orbital Roof Dermoid Cysts With Dural Invasion.

PURPOSE: To demonstrate the technique and report the results of endoscopic-assisted lateral orbitotomy for 6 patients with huge intraorbital dermoid cyst causing orbital roof bone erosion and dural invasion. METHODS: Patients had unilateral cystic tumor with proptosis and hypoglobus for more than 6 months. There was no compressive optic neuropathy. Lateral orbitotomy procedure was performed from 2004 to 2016 by 1 surgeon. Cysts were dissected, and fluid content was aspirated to reduce the size. Solid contents were then suctioned, its cavity was repeatedly irrigated, and orbital part of epithelial lining was removed. The remained epithelial lining and keratinized content at the orbital roof (abutting the dura) were removed using the rigid endoscope lenses (4 mm, 0° and 30°) and curettage. Orbital tissue was pulled away from the roof (inferior) by an assistant surgeon to make a space for introducing the lens and curette. The surgical field was frequently irrigated. No orbital drain was used, and all the patients were discharged on the same day after 8-10 hours of observation. Skin sutures were removed 1 week later. RESULTS: They were 4 men and 2 women with age range of 19-48 years. A large superolateral orbital tumor with roof erosion and dural invasion was observed on imaging. Procedures were performed uneventfully. Dermoid was the pathological diagnosis. While one patient lost to follow up after 1 week, others had 6-18 months follow-up time with no recurrence. CONCLUSIONS: Endoscopic-assisted lateral orbitotomy approach provided a good field of view, illumination, and magnification to totally remove all the content and epithelial lining of very large orbital roof dermoid cysts with dural invasion.

Comparing Pentacam HR Screening Indices in Different Normal Corneal Thicknesses among Refractive Surgery Candidates.

Purpose: To compare Pentacam indices in normal eyes with different corneal thicknesses. Methods: It is a retrospective observational study. Ninety-six normal eyes of 96 patients who were referred for refractive surgery in a tertiary university-based hospital from October 2015 to April 2019 were recruited consecutively. Corneal keratometry as well as Pentacam's software Belin-Ambrósio Enhanced Ectasia Display (BAD) parameters including pachymetry progression indices (PPIs), maximum Ambrosio's relational thickness (ART-max), corneal elevations, normalized deviations, BAD total deviation value (BAD-D), and anterior surface indices were measured by Pentacam HR (Type 70900). The included were classified as thin (26 eyes), average (45 eyes), and thick (25 eyes) corneas with the thinnest point thickness of ≤496 µm, 497-595 µm, and ≥596 µm, respectively. The specificities of all parameters were calculated based on routine cut-off values. Results: The refraction, keratometry, and elevations were not different (P > 0.05). All PPIs (minimum, average, and maximum) of thick corneas were significantly lower than average and thin corneas (P < 0.001). ART-max increased by thickening of the cornea (P < 0.001). BAD-D score and normalized indices of pachymetric parameters decreased with the increase of thickness (P < 0.001), while specificities of all indices increased with corneal thickening. More than 96% of thick corneas were classified as normal PPI-max (24/25), ART-max (25/25), and BAD-D (25/25), while nearly <54% of thin corneas (14/26 for PPI-max, 9/26 for ART-max, and 12/26 for BAD-D) were normal. Conclusions: The pachymetry-related indices and BAD-D were different among normal corneas with various thicknesses. The specificities of PPIs, ART-max, and BAD-D of thin corneas were lower than in thick corneas.

Assessment of Utility in Migraine: Mapping the Migraine-Specific Questionnaire to the EQ-5D-5L.

INTRODUCTION: There are increasing demands for studies of cost-effectiveness to allocate resources for disease prevention and treatment strategies. The aim of this study is to measure quality of life in migraineurs, based on the Migraine-Specific Questionnaire (MSQ) and EQ-5D-5L, and thereafter map an algorithm to estimate health-state utility values from the MSQ in individuals with migraine. METHODS: In this cross-sectional study conducted between May and July 2018 in a tertiary headache clinic in Tehran, Iran, migraineurs diagnosed based on International Classification of Headache Disorders (ICHD)-3ß were enrolled and were asked to complete the MSQ questionnaire and EQ-5D questionnaire. The Spearman correlation coefficient (ρ) was calculated to measure the correlation between the EQ-5D-5L and MSQ v2.1 domains' score. A P value of <.05 was considered statistically significant. After statistical analysis, several regression models were presented to map the results of the MSQ domains to the utility index, and the preferred model was achieved based on goodness of fit and the model's predictive performance. RESULTS: The preferred MSQ algorithm had approximately the same prediction errors in all migraineurs, episodic and chronic migraine (root mean square error 0.24, 0.24, and 0.23, respectively). The preferred MSQ model explained a variance of 0.26 (R2) in episodic and 0.38 in chronic migraine in the EQ-5D-5L questionnaire. CONCLUSION: The preferred MSQ mapping algorithm will be suitable in estimating health state utilities in trials of patients with migraine that contain MSQ scores but lack utility values.